District of Columbia Administrative Code

399 DEFINITIONS "Abuse" - any knowing, reckless, or intentional act or omission by a provider that causes or is likely to cause or contribute to, or which caused or is likely to have caused or contributed to, physical or emotional injury, death, or financial exploitation of a con…

3000 GENERAL PROVISIONS 3000.1 Free Standing Mental Health Clinic (FSMHC) services are services provided by behavioral health practitioners within a clinic setting to eligible individuals (consumers) living in the community. The purpose of these rules is to set forth the requirem…

3001 ELIGIBLE CONSUMERS 3001.1 Consumers eligible for Medicaid-funded FSMHC services must meet the following requirements: (a) Are enrolled in Medicaid, or be eligible for enrollment and have an application pending; and (b) Are children, youth, or adults with a mental health cond…

3002 CERTIFICATION PROCESS 3002.1 Free Standing Mental Health Clinic (FSMHC) providers shall be certified in accordance with the requirements of this section. 3002.2 Each applicant seeking certification as an FSMHC shall submit a certification application in the format required b…

3003 DENIAL AND DECERTIFICATION PROCESS 3003.1 The Director may deny initial certification if the applicant fails to comply with any certification standard or the application fails to demonstrate the applicant’s capacity to deliver high quality FSMHC services on a sustained and r…

3004 CERTIFICATION REQUIREMENTS: GENERAL 3004.1 The purpose of certification is to ensure that FSMHC have the necessary qualifications and capacity to provide high quality mental health services to District residents. 3004.2 The FSMHC shall conform with Federal and local laws and…

3005 STAFFING AND ADMINISTRATION 3005.1 Each FSMHC shall be staffed with licensed behavioral health practitioners who shall be professionally responsible for the provision of the mental health services delineated in its approved provider agreement. 3005.2 Each FSMHC shall have a …

3006 PROGRAM MANUAL 3006.1 Each FSMHC shall have a current program manual that outlines all of its policies and procedures. 3006.2 The program manual shall, at a minimum, include, the following: A mission statement reflecting the goals and mission of the Department; The range of …

3007 RECORDS 3007.1 In order to ensure that the treatment provided and reimbursed by the District is of the highest quality and fully meets all standards for certification and reimbursement, each participating FSMHC shall maintain consumer records and individual plans of care in …

3008 MEDICAL RECORDS 3008.1 All phases of the consumer’s treatment and related information shall be entered in the consumer’s medical record. 3008.2 The FSMHC shall utilize an EHR system certified by the Department of Health and Human Services Office of the National Coordinator f…

3009 INDIVIDUAL PLAN OF CARE 3009.1 Each FSMHC shall develop an individual plan of care for each consumer. Copies of individual plans of care shall be filed in consumer records. 3009.2 The plans of care shall include the following: (a) A written assessment of the consumer's curre…

3010 REIMBURSEMENT 3010.1 In order to be reimbursed, FSMHC services shall be medically necessary, reasonable in duration, and in full compliance with this chapter. A participating FSMHC shall agree to accept as payment in full the amount determined by DHCF or the Department, as a…

3011 COMPLIANCE AND INTEGRITY PROGRAM 3011.1 Each provider shall establish and adhere to a plan for ensuring compliance with the Medicaid program and this regulation. Each provider shall submit its Corporate Compliance Plan and any modifications thereto to the Department as part …

3012 AUDITS AND REVIEWS 3012.1 This Section sets forth the requirements for audits and reviews of FSMHC services and provider records. The Department, DHCF, and the D.C. Office of the Inspector General Medicaid Fraud Control Unit, among other entities, may conduct audits and revi…

3013 REPORTING MAJOR UNUSUAL INCIDENTS 3013.1 An FSMHC shall immediately notify the Department of any major unusual incident that may adversely affect the health, safety, or welfare of any enrolled consumer by submitting a completed Department Major Unusual Incident (MUI) Report …

3014 NOTICES OF INFRACTION 3014.1 The Department may issue a Notice of Infraction (NOI) for any violation of this chapter. The fine amount for any NOI issued under this chapter shall be as follows: For the first offense five hundred dollars ($500.00); For the second offense one t…

3015 BEHAVIORAL HEALTH ACCREDITATION 3015.1 Effective October 1, 2023, all Free-Standing Mental Health Clinic (FSMHC) providers shall obtain and maintain in good standing behavioral health accreditation with at least one (1) of the following organizations: the Commission Accredit…

3099 DEFINITIONS 3099.1 When used in this chapter, the following terms and phrases shall have the meanings ascribed: Clinical Administrator – an independently licensed behavioral health practitioner, as defined in this chapter, who has the authority and responsibility for the con…

3300 DC COMMUNITY SERVICE AGENCY CONSUMER TRANSITION VOUCHER 3300.1 These rules establish the requirements, formula, and process for a Consumer Transition Voucher (“CTV”) payment to a Core Services Agency (“CSA”), Assertive Community Treatment ("ACT") Program or Community Based I…

3301 WAIVER OF RULES 3301.1 Upon determination of good cause, the Director may waive any provision under this chapter subject to the statutory limitations of other District laws. The Director shall provide each waiver in writing and shall support each waiver by documentation of t…

3302 CONSUMER TRANSITION VOUCHER AMOUNT 3302.1 The CTV payment is $787.50 per newly enrolled consumer during the transition period. DMH-certified providers are eligible to submit a claim for the CTV if they enroll and conduct an initial intake of DCCSA consumers between January 2…

3303 ELIGIBILITY 3303.1 A CSA, ACT Program, or CBI Program that enrolls a consumer transferring from the DCCSA during the transition period as evidenced by a CSA Transfer Event in eCura shall be eligible for the CTV by submitting a claim through the Department’s eCura system as d…

3304 PAYMENT OF VOUCHER 3304.1 The Department has established a billing code – the Transitional Care Case Rate (“TCR”) - to be used by the consumer’s clinical home for payment of the CTV. 3304.2 The total CTV payment will be provided in increments of 50% for the first claim, 25% …

3399 DEFINITIONS Assertive Community Treatment or “ACT” - Assertive Community Treatment (ACT). An evidenced-based practice model that provides a proactive, consumer driven, intensive, integrated rehabilitative, crisis, treatment, and mental health rehabilitative community support…

3400 GENERAL PROVISIONS 3400.1 The Department of Behavioral Health (“Department”) is the state mental health authority with the responsibility to plan, develop, coordinate, and monitor comprehensive and integrated behavioral health systems of care for adults and for children, you…

3401 MHRS PROVIDER CERTIFICATION PROCESS 3401.1 The Department shall utilize the certification process to thoroughly evaluate the applicant’s capacity to provide high quality MHRS in accordance with this regulation and the needs of the District’s behavioral health system. 3401.2 …

3402 EXEMPTIONS FROM CERTIFICATION STANDARDS 3402.1 Upon good cause shown, the Department may exempt an applicant or MHRS provider from a certification standard if the exemption does not jeopardize the health and safety of consumers, violates consumers’ rights, or otherwise confl…

3403 DENIAL OF CERTIFICATION OR DECERTIFICATION PROCESS 3403.1 The Director may deny initial certification if the applicant fails to comply with any certification standard or the application fails to demonstrate the applicant’s capacity to deliver high quality MHRS on a sustained…

3404 NOTICES OF INFRACTION 3404.1 The Department may issue a NOI for any violation of this chapter. The fine amount for any NOI issued under this chapter shall be as follows: For the first offense, five hundred dollars ($500.00); For the second offense, one thousand dollars ($1,0…

3405 PROVIDER DISCONTINUATION OF SERVICES, PROVIDER CLOSURES, AND CONTINUITY OF CONSUMER CARE 3405.1 An MHRS provider shall provide written notification to the Department at least ninety (90) calendar days prior to its impending closure or discontinuation of a subset of services,…

3406 SERVICE COVERAGE 3406.1 MHRS are those rehabilitative services rendered through Department-certified MHRS providers to eligible consumers who meet medical necessity for such services. 3406.2 MHRS offer a continuum of care for people with complex needs through intensive, comm…

3407 ELIGIBLE CONSUMERS 3407.1 Consumers eligible for Medicaid-funded MHRS shall meet the following requirements: (a) Be enrolled in Medicaid, or be eligible for enrollment and have an application pending; (b) Be a bona fide resident of the District, as defined in D.C. Official C…

3408 ENROLLMENT INTO AND AUTHORIZATION OF MHRS 3408.1 Enrollment is the process by which the Department ascertains a consumer’s eligibility for MHRS, and, if eligible for services, adds a consumer to the MHRS system of care and assigns them to an MHRS provider. 3408.2 No later th…

3409 CONSUMER PROTECTIONS 3409.1 Medicaid beneficiaries are entitled to Notice and Appeal rights pursuant to 29 DCMR § 9508 in cases of intended adverse action, such as an action to deny, discontinue, terminate, or change the manner or form of Medicaid-funded MHRS. The Department…

3410 CONSUMER CHOICE 3410.1 All consumers receiving MHRS shall have free choice of MHRS providers. 3410.2 Each MHRS provider shall establish and adhere to policies and procedures governing the means by which consumers shall be informed of the full choices of MHRS providers and ot…

3411 PLAN OF CARE DEVELOPMENT 3411.1 Each CSA shall coordinate the Plan of Care development for its enrolled consumers from the start of intake through discharge from the system of care, except that the Plan of Care development for consumers receiving: CBI, shall be coordinated b…

3412 PLAN OF CARE IMPLEMENTATION 3412.1 The consumer and assigned staff of the CSA, or when applicable pursuant to § 3411.1, staff of the CBI or ACT provider shall discuss the Plan of Care on an ongoing basis. The assigned staff shall record an encounter note describing the consu…

3413 MHRS PROVIDER QUALIFICATIONS--GENERAL 3413.1 Each MHRS provider shall be established as a legally recognized entity in the District of Columbia and qualified to conduct business in the District. A certificate of good standing issued by the District of Columbia Department of …

3414 CORE SERVICES AGENCY REQUIREMENTS 3414.1 Each CSA shall comply with the certification standards described in § 3413, the service specific standards applicable to core services, and the certification standards set forth in this section, as well as the other certification stan…

3415 SUB-PROVIDER AND SPECIALTY PROVIDER REQUIREMENTS 3415.1 Each sub-provider and specialty provider shall comply with the certification standards described in § 3413, the service specific standards applicable to the MHRS offered by the sub-provider or specialty provider, and th…

3416 QUALIFIED PRACTITIONERS AND CREDENTIALED STAFF 3416.1 Qualified practitioners and credentialed staff are permitted to provide Mental Health Rehabilitation Services (MHRS) or components of MHRS, as identified in this section, in accordance with; the applicable service specifi…

3417 COVERED MENTAL HEALTH REHABILITATION SERVICES 3417.1 The service specific standards described in this section apply to the individual MHRS offered by each MHRS provider and reimbursed by the District in accordance with this chapter. 3417.2 Covered core services shall be Diag…

3418 DIAGNOSTIC ASSESSMENT 3418.1 A Diagnostic Assessment is an intensive clinical and functional evaluation of a consumer’s mental health condition that results in the issuance of a Diagnostic Assessment report, including a clinical formulation, with recommendations for service …

3419 MEDICATION/SOMATIC TREATMENT 3419.1 Medication/Somatic Treatment services are medical services and interventions, including physical examinations; prescription, supervision, or administration of mental-health related medications; monitoring and interpreting results of labora…

3420 COUNSELING 3420.1 Counseling services are individual, group, or family face-to-face services for symptom and behavior management; development, restoration, or enhancement of adaptive behaviors and skills; and enhancement or maintenance of daily living skills. Adaptive behavi…

3421 COMMUNITY SUPPORT 3421.1 Community Support services are rehabilitation and environmental supports considered essential to assist the consumer in achieving rehabilitation and recovery goals that focus on building and maintaining a therapeutic relationship with the consumer. 3…

3422 CRISIS/EMERGENCY SERVICES 3422.1 A Crisis/Emergency Service is an immediate response face-to-face or via telehealth in accordance with 29 DCMR § 910 to an emergency situation involving a consumer with mental illness or emotional disturbance that is available twenty-four (24)…

3423 REHABILITATION DAY SERVICES 3423.1 Rehabilitation Day Services is a structured, clinical program intended to develop skills and foster social role integration through a range of social, psycho-educational, behavioral, and cognitive mental health interventions. Rehabilitation…

3424 INTENSIVE DAY TREATMENT 3424.1 IDT is a facility-based, structured, intensive, and coordinated acute treatment program which serves as an alternative to acute inpatient treatment or as a step-down service from inpatient care, and is rendered by an interdisciplinary team to p…

3425 COMMUNITY BASED INTERVENTION 3425.1 CBI services are time-limited, intensive, mental health services delivered to children and youth. CBI services are intended to prevent the utilization of an out-of-home therapeutic resource or a detention of the consumer. CBI services may …